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Residential soil and house dust were collected in St John's to assess the levels of lead exposure and potential human health risk. Although St John's does not have an identified, major point source for lead, nor is it a heavily industrialized or populated city, 51% of all analysed soil samples (n = 1231) exceeded the Canadian Council of Ministers of the Environment (CCME) residential soil lead guideline of 140 ppm, 26% exceeded the 400 ppm United States Environmental Protection Agency (US EPA) guideline for soil in children's play areas, and 9% exceeded the 1200 ppm US EPA guideline for soil outside of play areas. High soil lead concentrations, particularly those above 1200 ppm, are clustered in the older downtown core. Samples located along exterior house walls (dripline) have the highest mean soil lead concentrations, followed by open spaces in yards (ambient) and then roadside sites. Lead in dripline soil samples from older housing stock is sourced to lead-bearing paint. Lead from both dripline and ambient samples on properties developed between the 1940s and 1980s have a mixture of sources including coal ash, paint, and leaded gasoline. Approximately 12% of analysed house dust samples (n = 96) exceeded the US EPA guidelines for lead in indoor dust, all from pre-1950s housing and all associated with dripline soil lead concentrations greater than 900 ppm. Human health risk predictions suggest that, although the wider St John's community may not be at risk of adverse health effects, children living in pre-1970s housing may be exposed to increased risk. [ABSTRACT FROM AUTHOR]

Study Design: Clinical practice guidelines., Objectives: The objective was to update the 2016 version of the Canadian clinical practice guidelines for the management of neuropathic pain in people with spinal cord injury (SCI)., Setting: The guidelines are relevant for inpatient, outpatient and community SCI rehabilitation settings in Canada., Methods: The guidelines were updated in accordance with the Appraisal of Guidelines for Research and Evaluation II tool. A Steering Committee and Working Group reviewed the relevant evidence on neuropathic pain management (encompassing screening and diagnosis, treatment and models of care) after SCI. The quality of evidence was scored using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A consensus process was followed to achieve agreement on recommendations and clinical considerations., Results: The working group identified and reviewed 46 additional relevant articles published since the last version of the guidelines. The panel agreed on 3 new screening and diagnosis recommendations and 8 new treatment recommendations. Two key changes to these treatment recommendations included the introduction of general treatment principles and a new treatment recommendation classification system. No new recommendations to model of care were made., Conclusions: The CanPainSCI recommendations for the management of neuropathic pain after SCI should be used to inform practice., (© 2022. The Author(s).)

Objectives: Clinical practice guidelines (CPGs) help to translate best available evidence into clinical practice but can be challenging to keep current due to their resource intensive nature. A "living" process that is used to continually update CPGs may therefore be of value., Study Design and Setting: This pilot study assesses the development of a living CPG protocol based on the CanPainSCI CPG. Two "living CPG" update searches were performed; resource costs and acceptability were assessed by a research team across Australia and Canada RESULTS: Two updates were completed over 3 years. Literature searches and data extraction were completed by trainees on 119 and 58 papers. Eight papers were included and reviewed by 14 expert panel members. Resource usage included a total 43 hours of screening by trainees at $2,356 (USD), 24 hours of expert panel review at $3,141 (USD) and 30 hours of project management at $3,241 (USD). Reviewers were generally satisfied with the process. All reviewers agreed that incorporating a living guidelines approach would be useful., Conclusion: This paper outlines the process of maintaining a CPG through a living guideline process and provides resource costs and acceptability data which may aid stakeholders in the development of future CPGs., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Study Design: Multicenter, randomized, double-blind, placebo controlled, clinical trial., Objective: The objective of this paper is to evaluate the effectiveness of cannabinoids and an anti-inflammatory diet, alone and in combination, for the management of neuropathic pain (NP) after spinal cord injury (SCI)., Setting: Two Canadian SCI rehabilitation centers., Methods: A sample of 144 individuals with SCI will receive either an anti-inflammatory diet, cannabinoids or a placebo for 6 weeks. Following this, a combined effect of these treatments will be evaluated for a further 6 weeks. The primary outcome measure will be the change in NP as assessed by the numeric rating scale (NRS). Secondary outcomes will include changes in inflammation, mood, sleep, spasticity, cost-effectiveness, and function., Conclusion: This study will assess the efficacy of an anti-inflammatory diet and cannabinoids (individually and in combination) for the treatment of NP following SCI. Results may reveal a cost-effective, side-effect free intervention strategy which could be utilized for the long-term management of NP following SCI.